Practice Essentials

Benign tumors of the small bowel are rare clinical entities that often remain asymptomatic throughout life.^{[1, 2, 3, 4, 5]} Despite comprising 75% of the length and 90% of the surface area of the gastrointestinal (GI) tract, the small bowel harbors relatively few primary neoplasms and fewer than 2% of GI malignancies.^[6]

Benign small-bowel tumors may develop as a single lesion or as multiple lesions of several subtypes. Subtypes include the following:

Hyperplastic polyps
Hamartomas
Adenomas
Gut stromal tumors
Lipomas
Hemangiomas
Those associated with Peutz-Jeghers syndrome ^[7]

A multicenter study from Taiwan found hamartomas and adenomas to be the most common benign small-bowel tumors.^[8]

Benign small-bowel tumors are generally characterized by slow growth and delayed clinical presentation. They often remain inherently asymptomatic, only to be discovered incidentally at autopsy.

Strict medical management currently has no role in benign small-bowel tumors. Surgical excision remains the recommended therapy for these tumors. (See Treatment.)

Pathophysiology

Benign small-bowel tumors may be found throughout the duodenum, jejunum, and ileum (in order of increasing frequency). Tumors may be single, multiple, or widespread (ie, as part of a polyposis syndrome). The following three growth patterns have been identified:

Intraluminal
Infiltrative
Serosal

Intraluminal lesions are most often associated with the development of secondary bowel obstruction and intussusception, whereas serosal lesions are linked to small-bowel volvulus.

Several factors have been suggested to explain both the scarcity of small-bowel lesions and the infrequency of their malignant transformation, as follows^[9]:

First, rapid intestinal transit through the small bowel limits contact time to the small-bowel mucosa
Second, greater fluidity of small-bowel chyme may dilute luminal irritants
Third, alkaline pH may play a role, as may the low bacterial colony counts of the small bowel
Finally, higher levels of benzyl peroxidase (thought to detoxify potential carcinogens) have been detected in the small bowel

Together, with increased levels of immunoglobulin A and widespread gut lymphoid tissue, these factors may impede the growth and development of tumors and their malignant transformation.

Epidemiology

Benign small-bowel lesions have been documented in persons of all age groups, though the mean age of presentation reportedly is between the fifth and sixth decades of life. Several series have noted a slight predominance in males compared to females. No racial or ethnic predisposition has been discovered.

Clinical Presentation

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Media Gallery

Benign neoplasm of the small intestine. Arteriogram demonstrating small bowel gut stromal tumor, indicated by round tumor blush in lower right corner of the image.
Benign neoplasm of the small intestine. Intraoperative view of an ependymal small bowel stromal tumor. Notice the narrow lesion stalk and high degree of vascularity.
Benign neoplasm of the small intestine. Cross section of a gross ependymal small bowel stromal tumor after removal. Mixed stromal elements and a high degree of cellularity are apparent.